Written evidence submitted by the Care and Support Alliance [ASC 011]

Introduction

1. The Care and Support Alliance (CSA) was established in July 2009. We represent over 70 leading charities campaigning for a properly funded social care system in England alongside the millions of older people, disabled people and their carers who need decent care. Social care is essential in supporting working age disabled people, older people and unpaid carers to live healthy, fulfilled and independent lives. As well as providing essential support with tasks like washing, dressing and eating, social care also plays a vital role in enabling hundreds of thousands of people to work, volunteer, take part in their community and reduce their risks of social isolation and loneliness. It can also prevent avoidable state expenditure, particularly on NHS and health services.

2. This response sets out why the current social care funding system is unsustainable, how it has been impacted by the pandemic, and how it is still failing people who need care and support. It highlights why the Government must address the short-term funding gap and put forward fundamental reform and a long-term solution that is sufficient, fair and works for working age adults, older people and unpaid carers. This response sets out the CSA’s recommendations for how to do this.

Overview of social care funding

The social care system has long faced significant financial strain, which has been further exacerbated by the coronavirus pandemic. The system has consistently been underfunded amidst growing demand for support, and this has meant that councils have often had to make difficult choices about people’s care. As a result, even before the pandemic we know that at least 1.6 million older people and disabled people were already not getting the social care they need in their everyday lives to do the things others take for granted before the coronavirus outbreak.[1] We also know, from data gathered through surveys across CSA members, that during the first national lockdown people went without their usual support and saw their care packages cut. As the pandemic has continues, we’re worried that people continue to fall through the gaps as support has not returned to pre-pandemic levels.

4. Between 2010/11 and 2018/19 total spending by the state on adult social care fell by £86 million in real terms. Matched with increasing demand, spend per head of the adult population has fallen by 6% per person. When adjusted for the change in population size by age, in real terms spending per head of the adult population is estimated to have fallen by 12%.[2]

5. In late 2020, the CSA carried out another survey to gather the experiences of people who have needed care throughout the coronavirus pandemic – our findings show that thousands of people have seen their needs continue to go unmet during the pandemic. Shockingly, 1 in 7 people needing social care have needed hospital treatment because of a lack of social care and 1 in 4 said their health had deteriorated because of a lack of care[3]

6. As councils can’t afford to pay the real cost of care, self-funders are picking up the bill. On average, self-funders now pay 41% more for the same package of care as that arranged by and paid for by the local authority with state funding.[4]

7. Over the last few years, successive governments have recognised the urgent crisis the social care system has been in, and have – at several points – invested funding to keep the system from collapse on a short-term basis. But this has not resolved the structural and systematic problems faced by the system, meaning it continues to teeter on the edge. We’ve seen the effects of these fundamental problems and, crucially, the significant underfunding during the coronavirus pandemic. Councils and care providers have been providing care for the past year in exceptionally difficult circumstances, having to cope with increased workforce costs as a result of staff absence – on top of 110,000 staff vacancies that existed before the pandemic.[5]

8. We believe that despite the efforts of those working in the social care sector, especially care workers, the coronavirus pandemic has shown that the system is no longer fit for purpose and needs comprehensive reform.

9. These funding challenges are having an increasing and devastating impact on people who need social care. To tackle the social care system’s urgent pressures during the coronavirus pandemic, the Government has invested welcomed emergency funding, as well as a Winter Plan for social care, but we have heard from providers and councils across the country that they haven’t seen the increases in funding they so desperately need to meet the extra demands and challenges created by coronavirus. Emergency funding isn’t sufficient to keep the system going.

10. Beyond the short-term crisis, the coronavirus outbreak has demonstrated the urgent need for the Government to prioritise implementing long-term reform that includes a better funding system and guarantees people the access they need to affordable, high quality social care. We cannot see a repeat of what has happened during this outbreak, and the best way to ensure this is by reforming the funding of the system once and for all.

Disabled adults, older people and carers during the pandemic and what this means for funding

11. Working age disabled adults and older people have been disproportionately affected by the Covid-19 pandemic. 9 in 10 covid-19 related deaths have been among the over 65s, 2 in 5 covid-19 related deaths were care home residents and disabled people made up 6 in 10 of all Covid-19 related deaths in the UK.[6] They are most at risk of the virus and at least 2.2 million clinically extremely vulnerable were asked to shield during the lockdowns.

12. The result of long-term failings in the social care system have been exposed through the significant loss of life during the pandemic. Overall, there were 57,588 deaths in care homes during the period from 2 March to 12 June 2020. This represents approximately 26,230 ‘excess’ deaths compared with previous years.[7]

13. Social care services have been badly affected – many were stopped or cut, and many people declined to use services because of fears of catching the virus. Many people have likely fallen through the gap and are going without the care they need. Long term funding is urgently needed to stabilise and sustain the system beyond the pandemic so that vital care services are protected.

Long-term reform and funding for social care

14. Creating a fair, effective and sustainable social care system would have financial and societal benefits. It would lead to fewer people being unable to be discharged safely from hospital because there is no social care package available; fewer people forced into acute NHS services as a result of unmet care and support needs; fewer unpaid carers dropping out of employment; and more working-age adults supported to access work, volunteering, education and training.

15. Poor access to support: Due to the underfunding of the current system, fewer and fewer people are able to get support, in spite of demand continuing to increase. Our latest report, ‘A Cry for Hope: Why 2021 must be the year for social care reform’, found that 3 in 10 of the people we surveyed who had difficulties doing day-to-day activities said they never receives the help or assistance they needed, and 1 in 5 rarely or only sometimes received what they need.[8] Nearly 1 in 5 people said they had asked social services or their council for help during the pandemic but didn’t receive any. This is having a detrimental effect on people’s ability to go about their everyday lives, with more than 1 in 10 people we spoke to being unable to get food or shopping, whilst nearly 1 in 10 have missed medical appointments. A further 1 in 10 said they were often worried about how to cope and stay safe.

16. Cost of care: In the current care system, both working age disabled adults and older people face significant and often catastrophic costs as a result of needing care. With access to support becoming increasingly restricted, people are paying more and more towards the cost of their care; only significant reform to the system and more funding will prevent these costs increasing further.

Fragility of the care market: The lack of funding for social care has also been destabilising the care market, which increasingly means that people’s ability to find appropriate care is being limited. As the care market continues to struggle and more providers leave the market, people who need care are facing limited choices about what kind of care they can access. There are also significant challenges facing the adult social care workforce. High staff turnover, high staff vacancies and low pay are all impacting the quality of care people receive, despite the best efforts of those that work in social care.

17. Impact on the NHS: The persistent underfunding of social care has had a significant impact upon the NHS. We’ve long known the relationship between a lack of social care and extra pressure on health services. In early 2020, the number of people with dementia being admitted to hospital as a medical emergency was found to have risen by more than a third in five years, with a lack of social care blamed for the increase.[9] This has only continued throughout the pandemic, with our own report finding that 1 in 7 people we spoke to have needed hospital treatment because of a lack of social care.[10] More than a quarter said their health had deteriorated, adding pressure on already overstretched hospitals. A lack of care can have a dangerous effect on someone’s health and turn small or emerging health concerns into much bigger ones that require urgent treatment. For autistic people and/or people with learning disabilities, getting the right social care could play an important role in finally putting an end to people ending up in inpatient care because of living with significant unmet needs. Equally, older people and people with dementia face over-stays in hospital because of the absence of somewhere to discharge them to. It’s vital we get this right, to protect individuals and ensure the sustainability of our NHS.

18. Workforce recruitment and retention: Reforming the social care system in the long term will enable the pay of social care staff to be increased in recognition of their work throughout the coronavirus pandemic. A growing demand for care and support means we need the workforce to grow by an estimated 31% (500,000 jobs) by 2030.[11] Low pay is one of the key reasons providers struggle to recruit and retain care workers. If the Government does not provide additional funding to local government to fund this commitment, it risks further destabilising an already fragile care market, as the Association of Directors of Adult Social Services (ADASS) have warned.[12] In March 2021, the Scottish Government confirmed that all NHS staff in Scotland are to be offered a pay rise of at least 4%, and it would go a long way to see similar commitments made to social care staff in England.[13]

What reform is needed and what the CSA wants to see

19. In order to stabilise the care market, the Government must provide immediate and sufficient funding to Local Authorities and to care providers to stabilise the social care system between now and the end of 2021 – a time when it will be under extreme duress from the pandemic and its fall-out. We support the call of the Health Foundation for an immediate cash injection of £12.bn to recover peak spending and ensure a pay increase for staff.

20. The CSA recognises that it is important to solve the problem of catastrophic care costs, as a ‘cap’ would do, but believes that this is only one of a number of equally important weaknesses faced by social care, all of which need to be tackled if we’re to do right by older people, working age disabled people and unpaid carers.

21. The CSA wants to see a whole system change for social care, based on a number of core principles. We advocate for a fair, high quality and sustainable care system with the following features:

-          A system that pools the costs of care on a compulsory basis across the whole adult population, through taxation. The coronavirus outbreak has shown how important it is to bring health and social care on a level playing field and guarantee that the system is sufficiently funded to meet people’s needs.

-          A system that is free at the point of use for all working age adults and older people. We need a system that doesn’t leave people out because of the high cost of care. Our health service is free at the point of use and protects all those who need it equally. It is unfair that people who need social car bear so much of the responsibility and could lose out on support because of cost. In the end, this places additional strain on the NHS, because many people restrict or postpone support and end up needing more intensive and costly intervention as a result.

-          Eligibility should be expanded to ensure moderate levels of need are met. Even before the coronavirus pandemic, only people with high needs were getting support as a result of continued underfunding. Moving forward, we want to ensure that more people who need support can receive it. To make this a reality, the Government must ensure there is sufficient funding for councils to expand support.

-          There should be an independent, standardised national eligibility threshold and assessment process for social care. Currently, there’s a worrying postcode lottery of support that’s having a detrimental impact on the people our Alliance represents; and the geographic variation of the impact of coronavirus will have exacerbated this. It is important that there is a greater standardisation of support, so people aren’t left without support because of where they live. As local authority budgets have failed to keep up with demand over the years, care has been restricted to those with the most substantial needs. 40,000 fewer adults received support between 2013/14 than in 2009/10.[14] Waiting for people’s needs to get worse before offering support may result in unnecessary hospital admissions.

-          The needs of both working age adults and older people must be addressed. We need a social care system that works for everyone, regardless of their age. The Government must include working age disabled adults in its plans – it cannot afford not to take a whole system view, given 48.5% of adult social care expenditure is spent supporting working age adults and increasing numbers of people are living longer with complex needs.[15] We also need a system that looks at all parts of the social care system, not just care homes.

-          There must be increased support for unpaid carers, including helping carers to juggle work and care, increased financial support and respite care. The pandemic has again highlighted the truly invaluable support unpaid carers have been giving to the hundreds of thousands of people who need it across the country. However, this comes with an economic cost. Prior the outbreak, the equivalent of 600 people a day have given up work to provide unpaid care,[16] at a cost to their own financial situation but also at a cost to the economy of about £5.3 billion a year.[17] Our latest report also found that nearly 2 in 5 carers said their health had deteriorated because of their caring responsibilities.[18] Separate research has found that during the pandemic 4 in 5 unpaid carers are currently providing more care than before lockdown and 64% of carers have not been able to take any breaks at all in the last six months.[19] The Government must recognise their contributions but also provide the opportunity to juggle paid work and care by investing in sufficient social care.

22. In summary, the CSA believes that social care is in desperate need of transformational change and refinancing, but a cap on its own will not deliver it.

April 2021